This article gives information about the commonly used antifungal agents and general measures against fungal infections.
Fungi are microorganisms having a substance in their cell wall called chitin. Some types of fungus are edible, while other fungi like Aspergillus are hazardous and can cause life-threatening diseases. Different types of fungus can cause fungal infections. In some instances, fungi not ordinarily present inside the body can multiply out of control and cause an infection. Fungal infections can be contagious and may spread from one person to another person. In some cases, a person can catch fungal infections from infected animals, contaminated soil, or surfaces.
A fungal infection is otherwise known as mycosis. Though most fungi are harmless, some of them are capable of causing diseases under specific conditions. Fungi reproduce by releasing spores that might be picked up by direct contact or inhalation.
So, fungal infections are more likely to affect the skin, nails, or lungs. Fungi can also penetrate the skin, affect other organs and cause systemic diseases throughout the body. The common fungal infections are athlete's foot, jock itch, ringworm, vaginal yeast infection, oral thrush, and onychomycosis.
Though fungal infections can happen to anyone, they are more likely to develop in people having weakened immune systems. People who have weakened immune systems are,
1) Those who are currently hospitalized.
2) People taking medications that suppress the immune system.
3) Individuals living with HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome).
4) Those people undergoing treatment for cancer.
5) Transplant recipients.
Antifungal agents are medications given against fungal infections that commonly affect skin, hair, and nails. These medications work by killing fungus and preventing fungus from growing. Antifungal medicines are available as gels, creams, sprays, capsules, tablets, injections, and pessary. Antifungal agents are usually applied for two to three weeks twice daily. Over application can irritate sensitive and damaged skin. There are several types of antifungal drugs available to fight against fungal infections.
Azoles are the commonly used antifungal agents. This drug interferes with the enzyme responsible for creating fungal cell membranes. Then, this cell membrane becomes unstable, causing cell death.
The two subgroups of azole antifungals are Imidazoles and Triazoles. Imidazoles include Miconazole 2%, Clotrimazole 1%, Ketoconazole, Oxiconazole, and Econazole nitrate 1%. These antifungals are effective against dermatophytes (a type of fungus that causes tinea), candida species, and pityrosporum. Some examples of triazoles are Fluconazole, Itraconazole, Posaconazole and Voriconazole.
Polyenes kill fungal cells by making fungal cell walls more porous, which results in the fungal cells being prone to bursting. Examples of polyene antifungals are Amphotericin B and Nystatin.
Similar to azole antifungals, allylamines interfere with the enzyme involved in creating fungal cell membranes. The typical example of allylamine is Terbinafine, which is often used to treat fungal infections of the skin.
Echinocandins are a new type of antifungal drug. They work by inhibiting the enzyme involved in the formation of fungal cell walls. The examples of echinocandins are Anidulafungin, Caspofungin, and Micafungin.
Some types of antifungal agents work by a mechanism different from other types. Flucytosine is an antifungal drug that prevents fungal cells from making nucleic acids and proteins. Due to this, fungal cells can no longer grow and survive.
Flucytosine is used to treat systemic infections with Candida or Cryptococcus species. Griseofulvin works by preventing fungal cells from dividing to produce more cells. It is often used to treat skin, nails, and hair infections.
Systemic antifungal drugs treat systemic mycoses, which are fungal infections affecting internal organs. Systemic antifungals can either be fungicidal (kill the fungus) or fungistatic (inhibit fungal growth). Systemic antifungal therapy is also required when extensive lesions are present on the skin, and these rashes are resistant to topical therapy. Also, if the involvement includes scalp and nail, we will opt for systemic antifungal treatment.
The following are the different antifungal agents used to treat various fungal infections.
1) Tolnaftate 1% and Zinc undecylenate 10% are commonly used against yeast infections.
2) Nystatin is used for treating oral and vaginal candidiasis along with Hamycin intravaginal tablets.
3) Ciclopirox olamine 1% cream treats fungal infections such as jock itch.
4) Allylamines such as Terbinafine and Naftifine have limited effectiveness against tinea versicolor and candidiasis.
5) Application of benzylamines like Butenafine hydrochloride 1% once daily improves compliance, efficacy, and patient satisfaction.
6) Whitfield ointment is a mixture of 3% Salicylic acid (a keratolytic agent) and 6% Benzoic acid (a moderate antifungal) in a vaseline base. It reduces skin irritation and inflammation caused by burns and fungal infections.
7) Castellani's paint is prepared by mixing 10 mL of basic fuchsin, 4 mL of Boric acid, 2 g of Resorcin, 10 mL of acetone, and water to make it 100 mL. It protects skin from an infection occurring on minor cuts, scrapes, or burns.
8) Sodium Thiosulfate 25% and Selenium sulfide 25% are also used to treat tinea versicolor.
A person can follow these general measures to be safe against fungal infections.
Avoid heat, moisture, and maceration.
Dry the body folds, finger and toe webs thoroughly after bathing.
Footwear should not be tight. It should fit well and be non-occlusive.
Hyperhidrosis of the feet has to be controlled.
Proper drying and application of antifungal foot powder after swimming will be helpful.
Clothing, towels, and other personal objects have to be kept separately.
Children with tinea capitis should not be allowed to go to school until treatment is over.
Practice good hygiene.
Use clean clothes every day, especially socks and underwear.
Stay away from animals that show signs of a fungal infection, such as missing fur or frequent scratching.
Avoid walking barefoot, especially in bathrooms, locker room areas, gyms, and public bathing areas.
Discard old shoes, boots, slippers, and sneakers and avoid sharing footwear with others.
Fungal infections are uncomfortable or even painful. It may take several weeks or months to resolve with treatment. If a person feels that he has a fungal infection, he needs to seek the doctor as soon as possible to diagnose the type of infection. Antifungal medications are prescribed accordingly. In some cases, doctors might recommend changes in diet or some general measures or daily habits to prevent recurrence of fungal infections.
Last reviewed at:
17 Mar 2022 - 4 min read
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